Term
| What is the more concerning type of arrythmia? |
|
Definition
| Ventricular is more concern than supraventricular |
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Term
| What is another term for supraventricular? |
|
Definition
|
|
Term
| Do supraventricular (atrial) arrythmias have a large effect on cardiac output? |
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Definition
|
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Term
| What is sinus tachycardia? |
|
Definition
| tachycardia due to SA node rate increase |
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Term
| What is atrial fibrillation? |
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Definition
| irregularly irregular arrythmia of atria, 300-600 bpm with no pattern |
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Term
| What does PSVT stand for? |
|
Definition
| paroxysmal supraventricular tachycardia |
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Term
| What does AVNRT stand for? |
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Definition
| atrioventricular nodal re-entry tachycardias |
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Term
|
Definition
| Wolff-Parkinson-White syndrome |
|
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Term
| What is a regular vs irregular arrythmia? |
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Definition
| Regular are either too fast or too slow, irregular have non uniform tempo |
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Term
| Can sinus tachycardia be normal? |
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Definition
| yes, exercise induces increased heart rate, as does 'fight or flight' ANS stimulation |
|
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Term
| What are pathological causes of sinus tachycardia? |
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Definition
| anemia, hyperthyroidism, heart failure |
|
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Term
| What is sinus tachycardia's tx? |
|
Definition
| Treat underlying dx, or use agent that slows SA node |
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Term
| Name two drugs that treat sinus tachycardia |
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Definition
| beta blockers, calcium antagonists |
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Term
| Does Dr Smith condone scoring illicit propranolol if it will help you through a proficiency? |
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Definition
|
|
Term
| In atrial fibrillation, do the atria and ventricles beat together? |
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Definition
|
|
Term
| What is the ventricle contraction rate in atrial fibrillation? |
|
Definition
|
|
Term
| Is ventricle contraction rate regular in atrial fibrillation? |
|
Definition
|
|
Term
| What can cause atrial fibrillation? |
|
Definition
Classic' triad: rheumatic heart dx, EtOH (damages myocardium), thyrotoxicosis
Most common cause: HTN, HF (most common cause), stress, smoking, familial |
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Term
| What are tx's for atrial fibrillation? |
|
Definition
resolve underlying causes
slow ventricular contractions (beta blockers)
Prevent clotting (anticoagulants)
radiofrequency ablation
electrical cardioversion |
|
|
Term
| Name two drugs that prolongs AP's for atrial fibrillation |
|
Definition
| amiodarone or vernakalant |
|
|
Term
| Name two drugs that prevent coagulation in atrial fibrillation |
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Definition
|
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Term
| What sets the stage for clotting of blood and formation of thrombus/emboli? |
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Definition
| Any time blood is not moving quickly and efficiently, i.e. when the heart is beating irregularly |
|
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Term
| What are adverse ocular rxn's of amiodarone? |
|
Definition
90% develop corneal microdeposits
disc edema
optic neuritis (rare but permanent)
lens opacities |
|
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Term
| What is radiofrequency ablation? |
|
Definition
Pulmonary veins --> atria and have receptors that influence SA node in atria, therefore if they are destroyed, heartrate slows.
Some practitioners believe it is more effective than meds |
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Term
| What is a controversial tx of atrial fibrillation that may have fewer side effects than long term meds? |
|
Definition
|
|
Term
| What are adverse ocular rxn's of warfarin? |
|
Definition
subconjunctival hemorrhage
spontaneous hyphema
retinal hemorrhage
vitreous hemorrhage
cerebral hemorrhage (bad) |
|
|
Term
| What causes fine, brownish gold deposits in a whorl type pattern of iodine deposition in the cornea? |
|
Definition
AmIODarone (note iodine root)
Will go away in 6-8 months if discontinued
Harmless |
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Term
| What is AV Nodal re-entry tachycardia? |
|
Definition
| HR = 150 - 250 bpm caused by two functionally different paths through the AV node ( two different tissue types) |
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|
Term
| What are s/sx of AV nodal re-entry tachycardia? |
|
Definition
| palpitations, chest pain, dyspnea, pre-syncope, HR 150-250 |
|
|
Term
| What is the mechanism of AV Nodal re-entry tachycardia? |
|
Definition
| Two different pulses travel through the heart, causing irregular contraction |
|
|
Term
| What is AV node re-entry? |
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Definition
| When there are two signals, one fast and one slow, that are spaced such that eventually one signal induces premature contraction immediately after the other signal has already caused contraction. Heart ends up with an overall irregular, overstimulated HR |
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Term
| Are the extra heartbeats initiated by AV node re-entry tachycardia complete beats? |
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Definition
|
|
Term
| Who is more at risk for AV nodal re-entry tachycardia? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| dizzy, light headed feeling prior that often precedes passing out |
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|
Term
| What happens to cardiac output when the heart is in tachycardia? |
|
Definition
| filling is reduced --> reduced flow |
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|
Term
| How is AV nodal re-entry tachycardia treated? |
|
Definition
Mechanical: Induce increased vagal tone through carotid sinus massage, valsalva maneuver, head immersion in cold water
Medical: IV drugs to slow heart |
|
|
Term
| What does increased vagal tone do to AVNRT pt's? |
|
Definition
| Overrules aberrent AV node signal, resets heart to slower heartbeat |
|
|
Term
| What is the valsalva maneuver? |
|
Definition
| hold nose/mouth shut, and try to forcefully exhale against that resistance, can slow down heartbeat through ANS mechanism |
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|
Term
| What is Wolff-Parkinson-White Syndrome? |
|
Definition
| rapid hearbeat due to electrical transmission through the kent bundle, restimulating heartbeat (+ feedback loop --> tachycardia |
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|
Term
| What is a micro AV re entry vs a macro AV re entry dx? |
|
Definition
|
|
Term
| Who is more likely to have WPW syndrome? |
|
Definition
| men, though etiology may be just random or inherited (Wolf Parkinson White syndrome) |
|
|
Term
| What do Kent bundles do that can be pathological? |
|
Definition
| conduct heart impules in both directions leading to + feedback loop --> increased heartbeat |
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Term
| What kind of AV nodal malfunction is more prone to atrial fibrillation and thus deadly ventricular fibrillation? |
|
Definition
| WPW syndrome is more dangerous than AVNRT |
|
|
Term
| How is WPW syndrome treated? |
|
Definition
| meds or ablation, may just be observed |
|
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Term
| What is a sustained ventricul tachycardia often called? |
|
Definition
| ventricular tachyarrhythmias |
|
|
Term
| What does ventricular tachyarrhythmias often called? |
|
Definition
| premature ventricular beats |
|
|
Term
| What is the criteria for 'sustained' with regard to tachycardia? |
|
Definition
| greater than 30 seconds of tachycardia |
|
|
Term
| What is often the cause of ventricular tachycardia? |
|
Definition
| underlying structural heart disease |
|
|
Term
| What is impaired from sustained ventricular tachycardia? |
|
Definition
| Heart cannot fill properly, thus cardiac output is depressed |
|
|
Term
| What heart disorder often occurs paroxysmally? |
|
Definition
| sustained ventricular tachycardia can present with short, episodic s/sx |
|
|
Term
| What is ventricular fibrillation? |
|
Definition
| ZERO cardiac output due to completely disordered ventricular contraction |
|
|
Term
|
Definition
| fix this, from slide 15 of CV and PVD ppt |
|
|
Term
| What is used to treat SCD? |
|
Definition
| implanted cardioverter-defibrillators are used to treat |
|
|
Term
|
Definition
| Premature ventricular contractoin |
|
|
Term
| What s/sx present in PVC? |
|
Definition
| extra heartbeats arise directly from ventricles |
|
|
Term
|
Definition
| stress, age, caffeine, tobacco, alcohol, infection |
|
|
Term
| Does PVC affect the AV or SA node? |
|
Definition
| No, so the next sinus beat will occur as expected |
|
|
Term
| Does PVC increase the risk of death? |
|
Definition
| Only if it was originally caused by HF |
|
|
Term
|
Definition
|
|
Term
| What can cause sinus bradyarrhythmia? |
|
Definition
| hypothyroidism, drugs, CV athlete |
|
|
Term
| What can be used tro treat sinus bradyarrhythmia? |
|
Definition
atropine --> increases sinus rate
pacemaker implantation |
|
|
Term
|
Definition
| some impulses from SA node are not conducted to ventricles |
|
|
Term
| Where is the 'block' during AV block? |
|
Definition
| usually at AV node or His-Purkinje system |
|
|
Term
| What increases the risk of AV block? |
|
Definition
| increased age, medications |
|
|
Term
| What is 1st degree AV block? |
|
Definition
| prolonged AV conduction time, but impulse reaches ventricles |
|
|
Term
| What is second degree AV block? |
|
Definition
| intermitten failure of the impulse to get from the atrium to ventricles |
|
|
Term
| What type of AV block seldom needs tx, what type may require a pacemaker? |
|
Definition
1st degree --> seldom needs tx
2nd degree --> may need pacemaker |
|
|
Term
| What type of heart block has no observable s/sx? |
|
Definition
|
|
Term
| What is complete or third degree AV block? |
|
Definition
| no atrial impulses reach the ventricles, so AV node may take over for SA node, however spontaneous depolarization may occur --> 15-40 bpm |
|
|
Term
| What is the tx for 3rd degree AV block? |
|
Definition
|
|
Term
|
Definition
| inability of the heart to meet systemic bloodflow needs without compensatory mechanisms |
|
|
Term
| What was heart failure previously known as? |
|
Definition
| CHF: Congestive Heart Failure |
|
|
Term
| Is heart failure itself a dx? |
|
Definition
| No, it is the end result of primary dx/disorders |
|
|
Term
| How many people die of HF every year? |
|
Definition
|
|
Term
| How many people in the US are affected by HF? |
|
Definition
|
|
Term
| What is expected to double it's prevalence over the next 40 years? |
|
Definition
|
|
Term
| What % of pt's will be dead within 5 years of diagnosis? |
|
Definition
|
|
Term
| What are risk factors for HF? |
|
Definition
| age, smoking, obesity, EtOH, DM, HTN periodontal dx, hs-CRP dyslipidemia |
|
|
Term
| What is high sensitivity C-Reactive protein dislipidemia? |
|
Definition
|
|
Term
| What ocular sign indicates high risk of HF? |
|
Definition
| DM retinopathy, warrants a cardiac consult |
|
|
Term
|
Definition
| increased risk, but no s/sx or structural heart problems |
|
|
Term
|
Definition
| Structural heart dx present, but no s/sx |
|
|
Term
|
Definition
| pt with current or or past symptoms of HF such as shortness of breath |
|
|
Term
|
Definition
| refractory heart failure who might be eligible for specialized tx strategies |
|
|
Term
| What is the most common cause of HF? |
|
Definition
| ischemic heart dx (35-40%) |
|
|
Term
| What is the second most common cause of HF? |
|
Definition
|
|
Term
| What is the third most common cause of HF? |
|
Definition
|
|
Term
| What are other causes of HF besides the big 3? |
|
Definition
| valvular dx, drugs, EtOH, arrhythmias, pericardial dx, hypertrophic cardiomyopathy |
|
|
Term
| What does infarction mean? |
|
Definition
|
|
Term
|
Definition
1. left heart failure (more serious problem) is most common problem
2. right heart failure (most commonly caused by left heart failure)
3. high output vs low output heart failure
4. systolic vs diastolic heart failure (failure of heart to relax, cannot fill --> low output) |
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